Exam 1; Cell Injury, Cell Death, and Cell Adaptations

Question 1

This describes the origin of disease, including underlying cause and modifiers; WHY a disease occurs

Answer 1

etiology

Question 2

This describes the development of disease, from molecular/cellular changes to functional and structural abnormalities; HOW a disease occurs

Answer 2

pathogenesis

Question 3

True or False
Clinical signs and symptoms of disease are usually simultaneously associated with the biochemical changes associated with cell injury

Answer 3

False; the clinical signs and symptoms are usually several steps removed

Question 4

What four things can cause decreased O2 (hypoxia) or no O2 (anoxia)

Answer 4

impaired absorption of oxygen
decreased blood flow (ischemia)
disease of blood or blood vessels
inadequate oxygenation of the blood

Question 5

Decreased oxygen impairs this in the mitochondria

Answer 5

oxidative phosphorylation; which reduces the amount of ATP which reduces the ability of the plasma membrane to maintain homeostasis

Question 6

Decrease oxygen causes a net gain of what in the mitochondria

Answer 6

a net gain of solute and an isosmotic gain in cytoplasmic water; affects of the ion pumps

Question 7

When the mitochondria have an isosmotic gain in cytoplasmic water, what three things occur

Answer 7

1. cell swelling with the formation of cell surface blebs
2. swelling of mitochondria
3. dilation of the endoplasmic reticulum that leads to detachment of ribosomes from the RER and dissociation of polysomes and decrease in protein synthesis; increasing lipid deposition

Question 8

Reduced oxidative phosphorylation in the mito leads to an increase in what

Answer 8

glycolysis

Question 9

What happens to the mito where there is an increase in glycolysis

Answer 9

increased production of lactic acid and inorganic phosphates which decreases pH and leads to chromatin clumping

Question 10

This describes a reduced substrate for ATP production which can result in the same patterns as hypoxia/anoxia

Answer 10

hypoglycemia

Question 11

The generation of ROS can be associated with what 5 different processes

Answer 11

inflammation
oxygen toxicity
chemicals
irradiation
aging

Question 12

This type of ROS is inactivated spontaneously or by superoxide disputes (SOD) to form H2O2

Answer 12

superoxide

Question 13

This type of ROS is detoxified by glutathione peroxidase and catalase

Answer 13

hydrogen peroxide

Question 14

This type of ROS are generated by hydrolysis of water by ionizing radiation or by transitional metals such as Fe++ or Cu++

Answer 14

hydroxyl radicals

Question 15

In which three ways do ROS damage cells

Answer 15

lipid peroxidation
protein cross-linking
reacts with thymidine and guanine to induce single strand DNA breaks

Question 16

These systems in the body act to reduce the effects of ROS by blocking their initiation or by inactivating them

Answer 16

intracellular and extracellular antioxidant systems

Question 17

What are some examples of the intracellular antioxidant system

Answer 17

SOD
catalase
glutathione peroxidase

Question 18

What are some examples of the extracellular antioxidant system

Answer 18

vitamins E, A, C

serum proteins that bind free iron and copper

Question 19

ROS cause what type of damage to DNA

Answer 19

single stranded breaks

typically seen in thymidine and guanine

Question 20

How is the proper level of cytoplasmic Ca maintained

Answer 20

by protein sequestration in the cytoplasm, mito, and ER

Question 21

High levels of Ca will activate which four degradative enzymes

Answer 21

ATPase
phospholipases
endonucleases
proteases

Question 22

What are some additional ways a cell membrane can be injured

Answer 22

complement
cytotoxic T cells
virus
bacterial endotoxins and exotoxins
drugs

Question 23

True or False

biochemical alterations occur prior to morphologic changes

Answer 23

True

Question 24

The degree of cell injury is determined by what

Answer 24

physiologic state of the cell
cell type
intensity, duration and/or number of exposures to the etiological agent

Question 25

Cell injury may result in what four things

Answer 25

reversible cell injury cellular adaptations associated with changes in cell number, size, or differentiation cellular adaptations associated with abnormal accumulations cell death - necrosis or apoptosis

Question 26

This is acute in nature and occurs when the cell cannot maintain normal homeostasis due to cell injury of short duration and minimal intensity

Answer 26

reversible cell injury

Question 27

What are four common etiologies of a reversible cell injury

Answer 27

toxins infectious agents hypoxia thermal injury

Question 28

What are the two morphologic changes of a cell during reversible cell injury

Answer 28

plasma membrane injury leads to an increased intracellular Na that leads to an isosmotic gain in water - edema organelles and cells swill, and the organ may appear pale and swollen

Question 29

True or False | There is no signature biochemical event that equates with cell death

Answer 29

True

Question 30

What five morphologic changes take place during necrosis

Answer 30

cell swelling protein denaturation yielding a glassy homogeneous cytoplasm organelle breakdown may result in vacuolated cytoplasm nuclei changes inflammation

Question 31

The type of necrosis is dependent upon what

Answer 31

patterns of enzymatic degradation and by bacterial products when present

Question 32

This is the most common form of necrosis

Answer 32

coagulative; cytoplasmic proteins are coagulated

Question 33

What are the characteristics of coagulative necrosis

Answer 33

the nucleus is lost, but the eosinophilic outline of the cell is retained for a short time prior to being removed by the inflammatory response - cell outline, pink cytoplasm, anucleated cells

Question 34

This type of necrosis is when the tissue is totally digested by the release of lysosomal enzymes during the acute inflammatory response; often associated with focal bacterial or fungal infections, also seen in the CNS

Answer 34

liquefactive necrosis (pus)

Question 35

This type of necrosis is associated with M. tuberculosis infection; the tissue has a white and "cheesy" appearance on gross examination

Answer 35

caseous necrosis

Question 36

This type of necrosis is common in trauma to the breast or in cases of pancreatitis; adipose tissue has a chalky white-yellow appearance. "soap bubble" histologic appearance

Answer 36

fat necrosis

Question 37

What are the morphologic features of apoptosis

Answer 37

cell shrinkage chromatin condensation followed by fragmentation apoptotic bodies formation phagocytosis of the apoptotic bodies without a significant inflammatory response

Question 38

What types of disorders can be caused by excess apoptosis

Answer 38

``` AIDS ischemia neurodegenerative diseases myelodysplasia toxin induced liver injury ```

Question 39

What types of disorders can be caused by inhibition of apoptosis

Answer 39

cancer autoimmune diseases viral diseases

Question 40

What is the mechanism of action of apoptosis

Answer 40

signaling control and integration execution removal of dead cells

Question 41

What are the signaling methods involving apoptosis

Answer 41

direct signaling | regulation of mitrochondrial permeability

Question 42

These genes serve as an on/off switch that regulates the permeability of the mito during apoptosis

Answer 42

Bcl-2 gene family

Question 43

These Bcl genes inhibit apoptosis

Answer 43

Bcl-2 | Bcl-x

Question 44

These Bcl genes stimulate apoptosis

Answer 44

Bax | bak

Question 45

This is released from the outer mitochondria membrane and serves to disrupt the inhibitory function of Bcl-2 therefore FAVORING apoptosis

Answer 45

cytochorome c

Question 46

Apoptosis signaling pathways converge on an autocatalytic proteolytic cascade of what, which can "execute" the cell

Answer 46

caspases

Question 47

The mitochondria release this, that activated various enzymes like transglutaminases and endonucleases

Answer 47

Ca

Question 48

In which ways are the dead cells removed

Answer 48

phagocytosis of deal cells and macrophages | there is little/no inflammation

Question 49

How do apoptosis and necrosis differ in regards to stimuli

Answer 49

apoptosis - physiologic and pathologic | necrosis - hypoxia and toxins

Question 50

How do apoptosis and necrosis differ in regards to morphology

Answer 50

Apoptosis - single cell, shrinkage, condensed chromatic, intact plasma membrane, apoptotic bodies necrosis - multiple cells, swelling, lysed plasma membrane, organelle disruption

Question 51

How do apoptosis and necrosis differ in regards to the mechanism of DNA destruction

Answer 51

apoptosos - ATP dependent process, gene activation and endonuclease mediated DNA fragmentation necrosis - ATP independent process, random, diffuse, ROS, membrane injury

Question 52

How do apoptosis and necrosis differ in regards to tissue reaction

Answer 52

apoptosis - minimal inflammation, phagocytosis of apoptotic bodies necrosis - inflammation

Question 53

cells undergo this type of change due to persistent (chronic) stresses

Answer 53

adaptative changes

Question 54

True or False | morphologic changes seldom specific to the type of persistent stress

Answer 54

True

Question 55

This is a decrease in cell size and function with concurrent decrease in organ size and/or function

Answer 55

atrophy

Question 56

What are some etiologies of atrophy

Answer 56

``` decreased workload loss of innervation decreased blood supply inadequate nutrition decreased hormonal stimulation aging local pressure ```

Question 57

This is an increase in cell size and function with concurrent increase in organ size and/or function

Answer 57

hypertrophy

Question 58

What are the etiologies of hypertrophy

Answer 58

increased functional demand increased or imbalanced nutrition increased hormonal stimulation

Question 59

This is an increase in cell number with concurrent increase in organ size and/or function

Answer 59

hyperplasia

Question 60

What are the etiologies of hyperplasia

Answer 60

hormones and growth factors | wound healing

Question 61

This is the alteration in cell differentiation with concurrent alteration of tissue/organ function one adult cell type is replaced by another adult cell type in response to chronic stress

Answer 61

metaplasia

Question 62

What are the etiologies of metaplasia

Answer 62

intestional; replacement of normal epithelium to intentional mucus-type cells squamous; normal columnar epithelium to stratified squamous (smokers)

Question 63

What are the categories of cell accumulations

Answer 63

excess of normal cellular constituent such as H20, lipids, proteins, and carbohydrates, and pigments that may be endogenous or exogenous

Question 64

What are the four mechanisms of intracellular accumulations

Answer 64

abnormal metabolism lack of an enzyme abnormal protein folding or transport ingestion of indigestible material

Question 65

What can occur with lipid accumulation

Answer 65

steatosis (fatty liver); abnormal accumulation of triglycerides within the parenchymal cells of the liver, heart, kidney, and muscles

Question 66

What can be the etiology of steatosis

Answer 66

``` obesity diabetes EtOH anorexia toxins protein malnutrition ```

Question 67

What is the gross appearance of steatosis

Answer 67

enlarged yellow (liver)

Question 68

What is the microscopic appearance of steatosis

Answer 68

hepatocytes contain clear cytoplasmic vacuoles that displace the nucleus

Question 69

This accumulates primarily in macrophages; in the sub epithelial macrophages forming xanthoma and in the vessels forming atheromas

Answer 69

cholesterol

Question 70

What is the histology of protein accumulation

Answer 70

eosinophilic cytoplasmic droplets, vacuoles, or aggregates

Question 71

What are some examples of disorders of protein accumulation

Answer 71

``` ɑ-1-anti-trypsin deficiency mallory bodies (improper folding) neurofibrillary tangles in Alzheimers ```

Question 72

What is the morphology of excess glycogen/glucose

Answer 72

clear, cytoplasmic/nuclear vacuoles

Question 73

What are some examples of exogenous pigmentation

Answer 73

carbon accumulated in macrophages, anthracosis vs. pneumoconiosis tattoos

Question 74

What are some examples of endogenous pigmentation

Answer 74

lipofuscin melanin hemosiderin bilirudin

Question 75

This is an endogenous pigment that is "wear and tear" "brown-yellow granular pigment a lipoprotein complex due to ROS preoxidation of membranes

Answer 75

lipofuscin

Question 76

This is an endogenous pigment that is black-brown, produced by melanocytes but accumulated in adjacent epidermal cells and in macrophages

Answer 76

melanin

Question 77

This is an endogenous pigment that is yellow-brown representing aggregates of ferritin micelles; accumulation from excess iron locally due to hemorrhage.

Answer 77

hemosiderin

Question 78

This is a genetic disease associated with cell death due to uncompensated hemosiderin accumulation

Answer 78

hemochromatosis

Question 79

This is an endogenous pigment that is yellow-brown and is the end product of heme metabolism; it accumulates in hepatocytes and bile ducts due to hemolysis, obstructed bile flow, and/or hepatocellular disease

Answer 79

bilirudin